Imaging the Meissner effect in hydride superconductors using quantum sensors

By directly altering microscopic interactions, pressure provides a powerful tuning knob for the exploration of condensed phases and geophysical phenomena1. The megabar regime represents an interesting frontier, in which recent discoveries include high-temperature superconductors, as well as structural and valence phase transitions2-6. However, at such high pressures, many conventional measurement techniques fail. Here we demonstrate the ability to perform local magnetometry inside a diamond anvil cell with sub-micron spatial resolution at megabar pressures. Our approach uses a shallow layer of nitrogen-vacancy colour centres implanted directly within the anvil7-9; crucially, we choose a crystal cut compatible with the intrinsic symmetries of the nitrogen-vacancy centre to enable functionality at megabar pressures. We apply our technique to characterize a recently discovered hydride superconductor, CeH9 (ref. 10). By performing simultaneous magnetometry and electrical transport measurements, we observe the dual signatures of superconductivity: diamagnetism characteristic of the Meissner effect and a sharp drop of the resistance to near zero. By locally mapping both the diamagnetic response and flux trapping, we directly image the geometry of superconducting regions, showing marked inhomogeneities at the micron scale. Our work brings quantum sensing to the megabar frontier and enables the closed-loop optimization of superhydride materials synthesis.

Universality of Critical Dynamics with Finite Entanglement

When a system is swept through a quantum critical point, the quantum Kibble-Zurek mechanism makes universal predictions for quantities such as the number and energy of excitations produced. This mechanism is now being used to obtain critical exponents on emerging quantum computers and emulators, which in some cases can be compared to matrix product state (MPS) numerical studies. However, the mechanism is modified when the divergence of entanglement entropy required for a faithful description of many quantum critical points is not fully captured by the experiment or classical calculation. In this Letter, we study how low-energy dynamics of quantum systems near criticality are modified by finite entanglement, using conformally invariant critical points described approximately by a MPS as an example. We derive that the effect of finite entanglement on a Kibble-Zurek process is captured by a dimensionless scaling function of the ratio of two length scales, one determined dynamically and one by the entanglement restriction. Numerically we confirm first that dynamics at finite bond dimension χ is independent of the algorithm chosen, then obtain scaling collapses for sweeps in the transverse field Ising model and the three-state Potts model. Our result establishes the precise role played by entanglement in time-dependent critical phenomena and has direct implications for quantum state preparation and classical simulation of quantum states.

SWAP Gate between a Majorana Qubit and a Parity-Protected Superconducting Qubit

High fidelity quantum information processing requires a combination of fast gates and long-lived quantum memories. In this Letter, we propose a hybrid architecture, where a parity-protected superconducting qubit is directly coupled to a Majorana qubit, which plays the role of a quantum memory. The superconducting qubit is based upon a π-periodic Josephson junction realized with gate-tunable semiconducting wires, where the tunneling of individual Cooper pairs is suppressed. One of the wires additionally contains four Majorana zero modes that define a qubit. We demonstrate that this enables the implementation of a SWAP gate, allowing for the transduction of quantum information between the topological and conventional qubit. This architecture combines fast gates, which can be realized with the superconducting qubit, with a topologically protected Majorana memory.

Direct geometric probe of singularities in band structure

A quantum system’s energy landscape may have points where multiple energy surfaces are degenerate and that exhibit singular geometry of the wave function manifold, with major consequences for the system’s properties. Ultracold atoms in optical lattices have been used to indirectly characterize such points in the band structure. We measured the non-Abelian transformation produced by transport directly through the singularities. We accelerated atoms along a quasi-momentum trajectory that enters, turns, and then exits the singularities at linear and quadratic band-touching points of a honeycomb lattice. Measurements after transport identified the topological winding numbers of these singularities to be 1 and 2, respectively. Our work introduces a distinct method for probing singularities that enables the study of non-Dirac singularities in ultracold-atom quantum simulators.

Residual neuromuscular blockade in the ICU: a prospective observational study and national survey

Residual neuromuscular blockade is associated with significant morbidity. It has been widely studied in anaesthesia; however, the incidence of residual neuromuscular blockade in patients managed in the ICU is unknown. We conducted a prospective observational study in a tertiary ICU to determine the incidence of residual neuromuscular blockade using quantitative accelerographic monitoring. We tested for residual neuromuscular blockade (defined as a train-of-four ratio < 0.9) before cessation of sedation in anticipation of tracheal extubation. We also surveyed 16 other ICUs in New Zealand to determine their use of neuromuscular monitoring. A total of 191 patients were included in the final analysis. The incidence (95%CI) of residual neuromuscular blockade was 43% (36-50%), with a similar incidence observed in non-postoperative and postoperative patients. There was a lower risk of residual neuromuscular blockade with atracurium than rocuronium (risk ratio (95%CI) of 0.39 (0.12-0.78)) and a higher risk with pancuronium than rocuronium (1.59 (1.06-2.49)). Our survey shows that, in New Zealand ICUs, monitoring of neuromuscular function is rarely carried out before tracheal extubation. When neuromuscular monitoring is undertaken, it is based on individual clinician suspicion and performed using qualitative measurements. No ICU reported using a quantitative monitor or a clinical guideline. The results demonstrate a high incidence of residual neuromuscular blockade in our ICU patients and identify the type of neuromuscular blocking drug as a possible risk factor. Monitoring neuromuscular function before tracheal extubation is not currently the standard of care in New Zealand ICUs. These data suggest that residual neuromuscular blockade may be an under-recognised problem in ICU practice.

Imaging gate-tunable Tomonaga-Luttinger liquids in 1H-MoSe2 mirror twin boundaries

One-dimensional electron systems exhibit fundamentally different properties than higher-dimensional systems. For example, electron-electron interactions in one-dimensional electron systems have been predicted to induce Tomonaga-Luttinger liquid behaviour. Naturally occurring grain boundaries in single-layer transition metal dichalcogenides exhibit one-dimensional conducting channels that have been proposed to host Tomonaga-Luttinger liquids, but charge density wave physics has also been suggested to explain their behaviour. Clear identification of the electronic ground state of this system has been hampered by an inability to electrostatically gate such boundaries and tune their charge carrier concentration. Here we present a scanning tunnelling microscopy and spectroscopy study of gate-tunable mirror twin boundaries in single-layer 1H-MoSe₂ devices. Gating enables scanning tunnelling microscopy and spectroscopy for different mirror twin boundary electron densities, thus allowing precise characterization of electron-electron interaction effects. Visualization of the resulting mirror twin boundary electronic structure allows unambiguous identification of collective density wave excitations having two velocities, in quantitative agreement with the spin-charge separation predicted by finite-length Tomonaga-Luttinger liquid theory.

Tea crude extracts effectively inactivate severe acute respiratory syndrome coronavirus 2

It is well known that black and green tea extracts, particularly polyphenols, have antimicrobial activity against various pathogenic microbes including viruses. However, there is limited data on the antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which emerged rapidly in China in late 2019 and which has been responsible for coronavirus disease 2019 (COVID‐19) pandemic globally. In this study, 20 compounds and three extracts were obtained from black and green tea and found that three tea extracts showed significant antiviral activity against SARS‐CoV‐2, whereby the viral titre decreased about 5 logs TCID₅₀ per ml by 1·375 mg ml⁻¹ black tea extract and two‐fold diluted tea bag infusion obtained from black tea when incubated at 25°C for 10 s. However, when concentrations of black and green tea extracts were equally adjusted to 344 µg ml⁻¹, green tea extracts showed more antiviral activity against SARS‐CoV‐2. This simple and highly respected beverage may be a cheap and widely acceptable means to reduce SARS‐CoV‐2 viral burden in the mouth and upper gastrointestinal and respiratory tracts in developed as well as developing countries.

Neural Network Representation of Tensor Network and Chiral States

We study the representational power of Boltzmann machines (a type of neural network) in quantum many-body systems. We prove that any (local) tensor network state has a (local) neural network representation. The construction is almost optimal in the sense that the number of parameters in the neural network representation is almost linear in the number of nonzero parameters in the tensor network representation. Despite the difficulty of representing (gapped) chiral topological states with local tensor networks, we construct a quasilocal neural network representation for a chiral p-wave superconductor. These results demonstrate the power of Boltzmann machines.

Spatiotemporal Crossover between Low- and High-Temperature Dynamical Regimes in the Quantum Heisenberg Magnet

The stranglehold of low temperatures on fascinating quantum phenomena in one-dimensional quantum magnets has been challenged recently by the discovery of anomalous spin transport at high temperatures. Whereas both regimes have been investigated separately, no study has attempted to reconcile them. For instance, the paradigmatic quantum Heisenberg spin-1/2 chain falls at low temperature within the Tomonaga-Luttinger liquid framework, while its high-temperature dynamics is superdiffusive and relates to the Kardar-Parisi-Zhang universality class in 1+1 dimensions. This Letter aims at reconciling the two regimes. Building on large-scale matrix product state simulations, we find that they are connected by a temperature-dependent spatiotemporal crossover. As the temperature T is reduced, we show that the onset of superdiffusion takes place at longer length and timescales ∝1/T. This prediction has direct consequences for experiments including nuclear magnetic resonance: it is consistent with earlier measurements on the nearly ideal Heisenberg S=1/2 chain compound Sr_{2}CuO_{3}, yet calls for new and dedicated experiments.

Four-Spin Terms and the Origin of the Chiral Spin Liquid in Mott Insulators on the Triangular Lattice

At strong repulsion, the triangular-lattice Hubbard model is described by s=1/2 spins with nearest-neighbor antiferromagnetic Heisenberg interactions and exhibits conventional 120° order. Using the infinite density matrix renormalization group and exact diagonalization, we study the effect of the additional four-spin interactions naturally generated from the underlying Mott-insulator physics of electrons as the repulsion decreases. Although these interactions have historically been connected with a gapless ground state with emergent spinon Fermi surface, we find that, at physically relevant parameters, they stabilize a chiral spin liquid (CSL) of Kalmeyer-Laughlin (KL) type, clarifying observations in recent studies of the Hubbard model. We then present a self-consistent solution based on a mean-field rewriting of the interaction to obtain a Hamiltonian with similarities to the parent Hamiltonian of the KL state, providing a physical understanding for the origin of the CSL.

Fighting antimicrobial resistance (AMR): Chinese herbal medicine as a source of novel antimicrobials - an update

Antimicrobial resistance (AMR) has now emerged as a global public health crisis, requiring the discovery of new and novel antimicrobial compounds, that may be precursors of future therapeutic antibiotics. Chinese Herbal Medicine (CHM) comes with a rich pedigree of holistic and empirical usage in Asia for the last 5000 years. Extracts of Anemarrhena asphodeloides Bunge, Angelica sinensis (Oliv.) Diels, Dianthus superbus L. Forsythiae fructus (Lian Qiao), Lonicerae flos (Jin Yin Hua), Naemorhedi cornu, Platycladus orientalis Franco, Polygonum aviculare, Polygonum cuspidatum, Poria cocos (Schw.), Rehmannia glutinosa (Gaertn.) DC, Rheum palmatum, Salvia miltiorrhiza Bunge, Scutellaria barbata, Scutellariae radix (Huang Qin) and Ursi fel (Xiong Dan) have shown to have antimicrobial properties against clinically significant Gram-negative and Gram-positive bacterial pathogens, as well as the mycobacteria (TB and non-tuberculous mycobacteria). Evidence is now beginning to emerge through systematic reviews of the outcomes of clinical studies employing CHM to treat infections. Of the 106 Cochrane systematic reviews on CHM, 16 (ca 15%) reviews examine CHM in the context of treating a specific infection disease or state. This update examines direct antimicrobial effect of CHM on bacterial pathogens, as well as synergistic effects of combining CHM with conventional antibiotics.

Realizing Hopf Insulators in Dipolar Spin Systems

The Hopf insulator is a weak topological insulator characterized by an insulating bulk with conducting edge states protected by an integer-valued linking number invariant. The state exists in three-dimensional two-band models. We demonstrate that the Hopf insulator can be naturally realized in lattices of dipolar-interacting spins, where spin exchange plays the role of particle hopping. The long-ranged, anisotropic nature of the dipole-dipole interactions allows for the precise detail required in the momentum-space structure, while different spin orientations ensure the necessary structure of the complex phases of the hoppings. Our model features robust gapless edge states at both smooth edges, as well as sharp edges obeying a certain crystalline symmetry, despite the breakdown of the two-band picture at the latter. In an accompanying paper [T. Schuster et al., Phys. Rev. A 103, AW11986 (2021)PLRAAN2469-9926] we provide a specific experimental blueprint for implementing our proposal using ultracold polar molecules of ^{40}K^{87}Rb.

Fungal vaccines

Invasive fungal disease continues to be a cause of significant life-threatening morbidity and mortality in humans, particularly in those with a diminished immune system, such as with haematological malignancies. The mainstay of treating such life-threatening fungal infection has been antifungal drugs, including azoles, echinocandins and macrocyclic polyenes. However, like antibiotic resistance, antifungal resistance is beginning to emerge, potentially jeopardizing the effectiveness of these molecules in the treatment of fungal disease. One strategy to avoid this is the development of fungal vaccines. However, the inability to provoke a sufficient immune response in the most vulnerable immunocompromised groups has hindered translation from bench to bedside. This review will assess the latest available data and will investigate potential Aspergillus antigens and feasible vaccine techniques, particularly for vaccination of high-risk groups, including immunocompromised and immunosuppressed populations.

Enhanced Coherence in Superconducting Circuits via Band Engineering

In superconducting circuits interrupted by Josephson junctions, the dependence of the energy spectrum on offset charges on different islands is 2e periodic through the Aharonov-Casher effect and resembles a crystal band structure that reflects the symmetries of the Josephson potential. We show that higher-harmonic Josephson elements described by a cos(2φ) energy-phase relation provide an increased freedom to tailor the shape of the Josephson potential and design spectra featuring multiplets of flat bands and Dirac points in the charge Brillouin zone. Flat bands provide noise-insensitive energy levels, and consequently, engineering band pairs with flat spectral gaps can help improve the coherence of the system. We discuss a modified version of a flux qubit that achieves, in principle, no decoherence from charge noise and introduce a flux qutrit that shows a spin-1 Dirac spectrum and is simultaneously quite robust to both charge and flux noise.

Intrinsic Anomalous Hall Conductivity in a Nonuniform Electric Field

We study how the intrinsic anomalous Hall conductivity is modified in two-dimensional crystals with broken time-reversal symmetry due to weak inhomogeneity of the applied electric field. Focusing on a clean noninteracting two-band system without band crossings, we derive the general expression for the Hall conductivity at small finite wave vector q to order q^{2}, which governs the Hall response to the second gradient of the electric field. Using the Kubo formula, we show that the answer can be expressed through the Berry curvature, Fubini-Study quantum metric, and the rank-3 symmetric tensor which is related to the quantum geometric connection and physically corresponds to the gauge-invariant part of the third cumulant of the position operator. We further compare our results with the predictions made within the semiclassical approach. By deriving the semiclassical equations of motion, we reproduce the result obtained from the Kubo formula in some limits. We also find, however, that the conventional semiclassical description in terms of the definite position and momentum of the electron is not fully consistent because of singular terms originating from the Heisenberg uncertainty principle. We thus present a clear example of a case when the semiclassical approach inherently suffers from the uncertainty principle, implying that it should be applied to systems in nonuniform fields with extra care.

Criticality of Two-Dimensional Disordered Dirac Fermions in the Unitary Class and Universality of the Integer Quantum Hall Transition

Two-dimensional (2D) Dirac fermions are a central paradigm of modern condensed matter physics, describing low-energy excitations in graphene, in certain classes of superconductors, and on surfaces of 3D topological insulators. At zero energy E=0, Dirac fermions with mass m are band insulators, with the Chern number jumping by unity at m=0. This observation lead Ludwig et al. [Phys. Rev. B 50, 7526 (1994)PRBMDO0163-182910.1103/PhysRevB.50.7526] to conjecture that the transition in 2D disordered Dirac fermions (DDF) and the integer quantum Hall transition (IQHT) are controlled by the same fixed point and possess the same universal critical properties. Given the far-reaching implications for the emerging field of the quantum anomalous Hall effect, modern condensed matter physics, and our general understanding of disordered critical points, it is surprising that this conjecture has never been tested numerically. Here, we report the results of extensive numerics on the phase diagram and criticality of 2D DDF in the unitary class. We find a critical line at m=0, with an energy-dependent localization length exponent. At large energies, our results for the DDF are consistent with state-of-the-art numerical results ν_{IQH}=2.56-2.62 from models of the IQHT. At E=0, however, we obtain ν_{0}=2.30-2.36 incompatible with ν_{IQH}. This result challenges conjectured relations between different models of the IQHT, and several interpretations are discussed.

Many-Body Chaos in the Sachdev-Ye-Kitaev Model

Many-body chaos has emerged as a powerful framework for understanding thermalization in strongly interacting quantum systems. While recent analytic advances have sharpened our intuition for many-body chaos in certain large N theories, it has proven challenging to develop precise numerical tools capable of exploring this phenomenon in generic Hamiltonians. To this end, we utilize massively parallel, matrix-free Krylov subspace methods to calculate dynamical correlators in the Sachdev-Ye-Kitaev model for up to N=60 Majorana fermions. We begin by showing that numerical results for two-point correlation functions agree at high temperatures with dynamical mean field solutions, while at low temperatures finite-size corrections are quantitatively reproduced by the exactly solvable dynamics of near extremal black holes. Motivated by these results, we develop a novel finite-size rescaling procedure for analyzing the growth of out-of-time-order correlators. Our procedure accurately determines the Lyapunov exponent, λ, across a wide range in temperatures, including in the regime where λ approaches the universal bound, λ=2π/β.

Successful disinfection of trumpet mouthpieces using domestic steam disinfection

There have been numerous reports in the literature describing the diversity of microbial flora isolated from woodwind and brass instruments, with potential infection risks for players, especially when such instruments are shared. Steam disinfection has become established as a trusted method of decontamination; however, there have been no reports on the employment of this technology to disinfect parts of musical instruments, hence it was the aim of this study to examine the fate of bacterial and yeast pathogens on artificially contaminated trumpet mouthpieces and to evaluate whether such disinfection is an effective method of disinfection for such instrument parts. Trumpet mouthpieces were artificially contaminated with 18 microbial strains (17 bacteria from four genera (Enterococcus, Escherichia, Staphylococcus and Streptococcus) and one yeast (Candida)), each at an inoculum density of approximately 1·5 × 10⁷ colony forming units and subjected to a disinfection cycle. The experiment was repeated including 50% (v/v) sterile sputum as soil. No bacteria or yeast organisms were recovered post disinfection, including following recovery and with nonselective cultural enrichment techniques.

Superdiffusive transport of energy in one-dimensional metals

Metals in one spatial dimension are described at the lowest energy scales by the Luttinger liquid theory. It is well understood that this free theory, and even interacting integrable models, can support ballistic transport of conserved quantities including energy. In contrast, realistic one-dimensional metals, even without disorder, contain integrability-breaking interactions that are expected to lead to thermalization and conventional diffusive linear response. We argue that the expansion of energy when such a nonintegrable Luttinger liquid is locally heated above its ground state shows superdiffusive behavior (i.e., spreading of energy that is intermediate between diffusion and ballistic propagation), by combining an analytical anomalous diffusion model with numerical matrix-product-state calculations on a specific perturbed spinless fermion chain. Different metals will have different scaling exponents and shapes in their energy spreading, but the superdiffusive behavior is stable and should be visible in time-resolved experiments.

NWChem: Past, present, and future

Specialized computational chemistry packages have permanently reshaped the landscape of chemical and materials science by providing tools to support and guide experimental efforts and for the prediction of atomistic and electronic properties. In this regard, electronic structure packages have played a special role by using first-principle-driven methodologies to model complex chemical and materials processes. Over the past few decades, the rapid development of computing technologies and the tremendous increase in computational power have offered a unique chance to study complex transformations using sophisticated and predictive many-body techniques that describe correlated behavior of electrons in molecular and condensed phase systems at different levels of theory. In enabling these simulations, novel parallel algorithms have been able to take advantage of computational resources to address the polynomial scaling of electronic structure methods. In this paper, we briefly review the NWChem computational chemistry suite, including its history, design principles, parallel tools, current capabilities, outreach, and outlook.

Interactions Remove the Quantization of the Chiral Photocurrent at Weyl Points

The chiral photocurrent or circular photogalvanic effect (CPGE) is a photocurrent that depends on the sense of circular polarization. In a disorder-free, noninteracting chiral Weyl semimetal, the magnitude of the effect is approximately quantized with a material-independent quantum e^{3}/h^{2} for reasons of band topology. We study the first-order corrections due to the Coulomb and Hubbatrd interactions in a continuum model of a Weyl semimetal in which known corrections from other bands are absent. We find that the inclusion of interactions generically breaks the quantization. The corrections are similar but larger in magnitude than previously studied interaction corrections to the (nontopological) linear optical conductivity of graphene, and have a potentially observable frequency dependence. We conclude that, unlike the quantum Hall effect in gapped phases or the chiral anomaly in field theories, the quantization of the CPGE in Weyl semimetals is not protected but has perturbative corrections in interaction strength.

Floquet Hopf Insulators

We predict the existence of a Floquet topological insulator in three-dimensional two-band systems, the Floquet Hopf insulator, which possesses two distinct topological invariants. One is the Hopf Z invariant, a linking number characterizing the (nondriven) Hopf topological insulator. The second invariant is an intrinsically Floquet Z_{2} invariant, and represents a condensed matter realization of the topology underlying the Witten anomaly in particle physics. Both invariants arise from topological defects in the system's time evolution, subject to a process in which defects at different quasienergies exchange even amounts of topological charge. Their contrasting classifications lead to a measurable physical consequence, namely, an unusual bulk-boundary correspondence where gapless edge modes are topologically protected, but may exist at either 0 or π quasienergy. Our results represent a phase of matter beyond the conventional classification of Floquet topological insulators.

Energy Drag in Particle-Hole Symmetric Systems as a Quantum Quench

Two conducting quantum systems coupled only via interactions can exhibit the phenomenon of Coulomb drag, in which a current passed through one layer can pull a current along in the other. However, in systems with particle-hole symmetry-for instance, the half filled Hubbard model or graphene near the Dirac point-the Coulomb drag effect vanishes to leading order in the interaction. Its thermal analog, whereby a thermal current in one layer pulls a thermal current in the other, does not vanish and is indeed the dominant form of drag in particle-hole symmetric systems. By studying a quantum quench, we show that thermal drag, unlike charge drag, displays a non-Fermi's golden rule growth at short times due to a logarithmic scattering singularity generic to one dimension. Exploiting the integrability of the Hubbard model, we obtain the long-time limit of the quench for weak interactions. Finally, we comment on thermal drag effects in higher dimensional systems.

Quantification of the Whole Lymph Node Vasculature Based on Tomography of the Vessel Corrosion Casts

Lymph nodes (LN) are crucial for immune function, and comprise an important interface between the blood and lymphatic systems. Blood vessels (BV) in LN are highly specialized, featuring high endothelial venules across which most of the resident lymphocytes crossed. Previous measurements of overall lymph and BV flow rates demonstrated that fluid also crosses BV walls, and that this is important for immune function. However, the spatial distribution of the BV in LN has not been quantified to the degree necessary to analyse the distribution of transmural fluid movement. In this study, we seek to quantify the spatial localization of LNBV, and to predict fluid movement across BV walls. MicroCT imaging of murine popliteal LN showed that capillaries were responsible for approximately 75% of the BV wall surface area, and that this was mostly distributed around the periphery of the node. We then modelled blood flow through the BV to obtain spatially resolved hydrostatic pressures, which were then combined with Starling’s law to predict transmural flow. Much of the total 10 nL/min transmural flow (under normal conditions) was concentrated in the periphery, corresponding closely with surface area distribution. These results provide important insights into the inner workings of LN, and provide a basis for further exploration of the role of LN flow patterns in normal and pathological functions.

The diagnosis and management of respiratory tract fungal infection in cystic fibrosis: A UK survey of current practice

Aspergillus fumigatus is commonly found in the airways of patients with cystic fibrosis (CF), and allergic bronchopulmonary aspergillosis (ABPA) is the most recognized associated clinical condition. However, accurate diagnosis remains challenging, and there is a paucity of clinical trials to guide clinical management of fungal disease. The aim of this survey was to assess the variability in current practice across the UK in diagnosis and management of fungal lung disease in CF patients. A 21 question anonymous online survey was sent to 94 paediatric and adult CF consultants in the UK. The response rate was 60.6% (32 adult physicians, 25 pediatricians) with 55 full and 2 partially completed surveys. For a first diagnosis of ABPA 20 (35.1%) treat with prednisolone alone, 38 (66.7%) use prednisolone with itraconazole and 2 (3.5%) choose voriconazole. Only 5 (8.8%) treat with prednisolone alone for a 1st relapse, 33 (58%) used prednisolone with itraconazole. To reduce treatment, 21 (36.8%) decrease steroids to zero over time and maintain azole therapy, 18 (31.6%) stop the azole and steroid after a fixed time, and 5 (8.8%) stop the azole after a fixed time and maintain a small steroid dose. Thirty-eight (66.7%) respondents believe Aspergillus colonization of the airway can cause clinical deterioration, and 37 (66.1%) would treat this. Scedosporium apiospermum infection has been diagnosed and treated by 35 (61.4%) of respondents. Results of this survey highlight the variance in clinical practice and the limited evidence available to guide management of fungal infection in CF.

Are patient education materials about cancer screening more effective when co-created with patients? A qualitative interview study and randomized controlled trial

Background

Patient education materials (pems) are frequently used to help patients make cancer screening decisions. However, because pems are typically developed by experts, they might inadequately address patient barriers to screening. We co-created, with patients, a prostate cancer (pca) screening pem, and we compared how the co-created pem and a pem developed by experts affected decisional conflict and screening intention in patients.

Methods

We identified and used patient barriers to pca screening to co-create a pca screening pem with patients, clinicians, and researchers. We then conducted a parallel-group randomized controlled trial with men 40 years of age and older in Ontario to compare decisional conflict and intention about pca screening after those men had viewed the co-created pem (intervention) or an expert-created pem (control). Participants were randomized using dynamic block randomization, and the study team was blinded to the allocation.

Results

Of 287 participants randomized to exposure to the co-created pem, 230 were analyzed, and of 287 randomized to exposure to the expert-created pem, 223 were analyzed. After pem exposure, intervention and control participants did not differ significantly in Decisional Conflict Scale scores [mean difference: 0.37 ± 1.23; 95% confidence interval (ci): -2.05 to 2.79]; in sure (Sure of myself, Understand information, Risk-benefit ratio, or Encouragement) scores (odds ratio: 0.75; 95% ci: 0.52 to 1.08); or in screening intention (mean difference: 0.09 ± 0.08; 95% ci: -0.06 to 0.24]).

Conclusions

The effectiveness of the co-created pem did not differ from that of the pem developed by experts. Thus, pem developers should choose the method that best fits their goals and resources.

Magnetoresistance Scaling Reveals Symmetries of the Strongly Correlated Dynamics in BaFe_{2}(As_{1-x}P_{x})_{2}

The phenomenon of T-linear resistivity commonly observed in a number of strange metals has been widely seen as evidence for the breakdown of the quasiparticle picture of metals. This study shows that a recently discovered H/T scaling relationship in the magnetoresistance of the strange metal BaFe_{2}(As_{1-x}P_{x})_{2} is independent of the relative orientations of current and magnetic field. Rather, its magnitude and form depend only on the orientation of the magnetic field with respect to a single crystallographic axis: the direction perpendicular to the magnetic iron layers. This finding suggests that the magnetotransport scaling does not originate from the conventional averaging or orbital velocity of quasiparticles as they traverse a Fermi surface, but rather from dissipation arising from two-dimensional correlations.

Does ivacaftor interfere with the antimicrobial activity of commonly used antibiotics against Pseudomonas aeruginosa?-Results of an in vitro study

WHAT IS KNOWN AND OBJECTIVE

Ivacaftor is a novel potentiator of defective cystic fibrosis transmembrane conductance regulator (CFTR) protein, which corrects the gating defect and increases ion-function of activated cell-surface CFTR. Bacteria also regulate their physiology through ion channels. However, little is known about the potential effects of ivacaftor on bacterial ion channels, which, in turn, may have a potential effect on transport across the bacterial cell membrane. Therefore, any change in the ability to transport molecules across cell membranes in bacteria could have an important impact on bacterial transport physiology. One area where this could be particularly important is in the movement of antibiotics, both into and out of the bacterial cell. An in vitro study was therefore performed to examine the influence of ivacaftor at therapeutic concentration on antibiotic susceptibility of 11 commonly used anti-pseudomonal antibiotics against a population of clinical Pseudomonas aeruginosa [PA], from CF and non-CF sources.

METHOD

Pseudomonas aeruginosa (n = 80; including 70 ivacaftor-naïve clinical PA from sputa from adult CF patients and 10 control PA from non-CF clinical blood culture sources) were examined. Antibiotic susceptibility was determined by standard disc diffusion assay using CLSI criteria and measuring zone size (mm), against four classes of anti-pseudomonal antibiotics, including beta-lactams (temocillin, ceftazidime, piperacillin/tazobactam, imipenem, meropenem and aztreonam), aminoglycosides (gentamicin, tobramycin, amikacin), fluoroquinolone (ciprofloxacin) and polymyxin (colistin), in the absence and presence of ivacaftor (5 μmol/L), as previously determined. In addition, all CF and non-CF PA were examined phenotypically in vitro, as previously described, for changes linked to bacterial virulence, including (i) growth density (ii) pigmentation, (iii) presence of adhesins and (iv) change to mucoidy, in the presence/absence of ivacaftor at therapeutic concentration.

RESULTS AND DISCUSSION

Antibiotic susceptibility did not decrease significantly with any of the antibiotics examined with CF PA isolates or with non-CF PA control organisms. There was a statistically significant increase in zone size (CF PA and amikacin, gentamicin, temocillin and ciprofloxacin; Non-CF PA and amikacin, gentamicin and aztreonam). However, at a population level, this did not translate into a shift in CLSI category to a more susceptible phenotype. None of the PA isolates examined were susceptible to ivacaftor alone, and additionally, no changes were noted with the four phenotypic parameters examined in the presence of ivacaftor.

WHAT IS NEW AND CONCLUSION

This study showed that antibiotic susceptibility of commonly used anti-pseudomonal antibiotics was not negatively affected by ivacaftor, in a population of ivacaftor-naive P. aeruginosa.

Meningococcal Disease in Northern Ireland - Past, Present & Future: MeningoNI Forum

Meningococcal disease has had devastating consequences in Northern Ireland since its first description locally in 1859. The incidence of this disease has significantly declined in recent years, however it is important to understand reasons for this changing epidemiology and to acknowledge the diagnostic and clinical management developments that have been made locally. This review aims to examine the changing face of this disease in Northern Ireland over the years, with particular reference to local disease prevention, epidemiology, diagnosis, clinical treatment and management, post-disease sequelae and the role of meningitis charities locally, in terms of patient support and research.

Incomplete Thermalization from Trap-Induced Integrability Breaking: Lessons from Classical Hard Rods

We study a one-dimensional gas of hard rods trapped in a harmonic potential, which breaks integrability of the hard-rod interaction in a nonuniform way. We explore the consequences of such broken integrability for the dynamics of a large number of particles and find three distinct regimes: initial, chaotic, and stationary. The initial regime is captured by an evolution equation for the phase-space distribution function. For any finite number of particles, this hydrodynamics breaks down and the dynamics becomes chaotic after a characteristic timescale determined by the interparticle distance and scattering length. The system fails to thermalize over the timescale studied (10^{4} natural units), but the time-averaged ensemble is a stationary state of the hydrodynamic evolution. We close by discussing logical extensions of the results to similar systems of quantum particles.

Topological Floquet-Thouless Energy Pump

We explore adiabatic pumping in the presence of a periodic drive, finding a new phase in which the topologically quantized pumped quantity is energy rather than charge. The topological invariant is given by the winding number of the micromotion with respect to time within each cycle, momentum, and adiabatic tuning parameter. We show numerically that this pump is highly robust against both disorder and interactions, breaking down at large values of either in a manner identical to the Thouless charge pump. Finally, we suggest experimental protocols for measuring this phenomenon.

In vitro antimicrobial activity of ceftolozane/tazobactam against Pseudomonas aeruginosa and other non-fermenting Gram-negative bacteria in adults with cystic fibrosis

OBJECTIVES

Pulmonary exacerbations in patients with cystic fibrosis (CF) caused by chronic Gram-negative bacterial infections are associated with reduced survival. These pathogens are usually treated with repeated courses of systemic antimicrobial agents. However, there is associated emergence of multidrug-resistant (MDR) pathogens. Ceftolozane/tazobactam (C/T) is a novel cephalosporin/β-lactamase inhibitor combination that has been demonstrated to have good activity against MDR Pseudomonas aeruginosa.

METHODS

In this study, C/T was compared with other commonly used intravenous antimicrobial agents against 193 non-fermenting Gram-negative bacteria isolated from CF sputum specimens, including P. aeruginosa, Achromobacter xylosoxidans, Stenotrophomonas maltophilia and Burkholderia cenocepacia. Minimum inhibitory concentrations (MICs) to C/T were determined by standard Etest assay and were interpreted according to current European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines.

RESULTS

C/T had good in vitro antimicrobial activity against CF clinical isolates of P. aeruginosa in comparison with other antimicrobial agents, with the exception of colistin. C/T also had activity against S. maltophilia but was not active against B. cenocepacia or A. xylosoxidans.

CONCLUSION

C/T showed excellent in vitro activity against P. aeruginosa CF clinical isolates. This antimicrobial agent is a potential therapeutic option when presented with challenging MDR P. aeruginosa and S. maltophilia exacerbations. Further clinical experience and trials in CF are required to determine the place of C/T in clinical practice.

Muddy puddles - the microbiology of puddles located outside tertiary university teaching hospitals

In the British Isles, the frequency of rain results in the formation of puddles on footpaths and roads in/around hospitals. No data are available demonstrating the microbiological composition of such puddles and therefore a study was undertaken to examine the microbiology of puddles in the grounds of two tertiary university-teaching hospitals (18 sites) and compared with control puddles from non-hospital rural environments (eight sites), estimating (i) total viable count; (ii) identification of organisms in puddles; (iii) enumeration of Escherichia coli: (iv) detection of Extended Spectrum β-Lactamase producing organisms and (v) direct antimicrobial susceptibility testing. A mean count of 2·3 × 10³  CFU per ml and 1·0 × 10⁹  CFU per ml was obtained for hospital and non-hospital puddles respectively. Isolates (n = 77; 54 hospital and 23 non-hospital) were isolated comprising of 23 species among 17 genera (hospital sites), where the majority (10/16; 62·5%) of genera identified were Gram-negative approximately, a fifth (20·6%) were shared by hospital and non-hospital rural samples. Escherichia coli was detected in half of the hospital puddles and under-half (37·5%) of the rural puddles extended spectrum β-lactamase organisms were not detected in any samples examined. Rainwater puddles from the hospital and non-hospital environments contain a diverse range of bacteria, which are capable of causing infections.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study demonstrated the presence of a wide diversity of bacterial taxa associated with rainwater puddles around hospitals, many of which are capable of causing human disease. Of clinical significance is the presence of Pseudomonas aeruginosa isolated from a hospital puddle, particularly for patients with cystic fibrosis. The presence of potentially disease-causing bacteria in puddles in and around hospitals identifies a new potential environmental reservoir of bacteria. Furthermore work is now needed to define their potential of entering or exiting hospital wards by contaminated footwear.